| NPI | 1558789156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: WI 4802-154) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: WA LL60467213) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2019-04-08 |